Scoliosis is a problem with the curve in your spine. Some curves in your spine are normal. But a few people have spines that make a large curve from side to side in the shape of the letter “S” or the letter “C.” If this curve is severe, it can cause pain and make breathing difficult.

The good news is that most cases of scoliosis are mild. If found early, they can usually be prevented from getting worse.

Scoliosis Bending Down

Scoliosis

What causes scoliosis?

Scoliosis usually starts in childhood. Scoliosis that is severe enough to need treatment is most common in girls.

A curve in the spine may get worse as your child grows, so it is important to find any problem early.

In most cases, the cause of scoliosis is not known. This is called idiopathic scoliosis. It develops mostly in children and teens and appears to be related to several things, including genetics, as it often runs in families.

There are two types of scoliosis: nonstructural and structural.

Nonstructural (functional) scoliosis

Nonstructural (functional) scoliosis involves a curve in the spine, without rotation, that is reversible because it is caused by a condition such as:

  • Pain or a muscle spasm.
  • A difference in leg length.

Structural scoliosis

Structural scoliosis involves a curve in the spine, with rotation, that is irreversible and is usually caused by an unknown factor (idiopathic) or a disease or condition such as:

  • Disorders that were present at birth (congenital), such as spina bifida, in which the spinal canal does not close properly; or a disorder that affects the formation of bones. These curves can be harder to correct. They often get worse as the child grows, especially during the teen years.
  • Nerve or muscle disorders, such as cerebral palsy, Marfan’s syndrome, or muscular dystrophy.
  • Injuries.
  • Infections.
  • Tumors.

In adults, scoliosis may result from changes in the spine due to aging (degenerative changes). These degenerative changes may be caused by osteoarthritis.

What are the symptoms?

Scoliosis most often causes no symptoms in your child until the spinal curve becomes large. You might notice these early signs:

  • Your child has one shoulder or hip that looks higher than the other.
  • Your child’s head does not look centered over the body.
  • Your child has one shoulder blade that sticks out more than the other.
  • Your child’s waistline is flat on one side, or the ribs look higher on one side when your child bends forward at the waist.

In adults, scoliosis may cause back pain and trouble breathing.

How is scoliosis diagnosed?

The doctor will check to see if your child’s back or ribs are even. If the doctor finds that one side is higher than the other, your child may need an X-ray so the spinal curve can be measured.

Scoliosis is most serious in young children who are still growing. A curve in the spine may get worse as your child grows. So many experts believe screening your child for scoliosis is important so that any curve in the spine can be found early and watched closely.

How is Scoliosis treated?

Mild cases of scoliosis usually do not need treatment. Your doctor will check the curve of your child’s spine every 4 to 6 months. If the curve gets worse, your child may need to wear a brace until he or she has finished growing. In severe cases, or if bracing doesn’t help, your child may need to have surgery.

Scoliosis and its treatment can be a severe strain on your child. Wearing a brace can feel and look odd. It also limits your child’s activity. Your child needs your support and understanding to get through treatments successfully.

What increases the risk of scoliosis?

Your child may be more likely to have scoliosis if someone in your family has had it and if your child is a girl. Other things that increase the chance of scoliosis include:

  • One of the bones in your child’s spine has moved forward out of place compared to the rest of the spine.
  • Your child’s arms or legs are missing or are abnormally short.
  • Your child has other problems with tissue growth that happened before birth.

When To Call a Doctor

Call your doctor to have your child evaluated for scoliosis if:

  • You observe a curve in your child’s spine.
  • You notice that something about your child’s posture looks unusual, such as ribs that stick out, one shoulder that is higher than the other, one hip that is higher than the other, or an uneven waistline.
  • You observe that your child’s clothes don’t fit properly or that his or her hems don’t hang evenly.
  • A school screening program recommends that your child see a doctor.

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Anterior cruciate ligament (ACL) injuries in children and teens are less common than in adults. But they do occur, especially in teens. An injury that hasn’t been treated (or one in which the treatment didn’t work) can lead to future knee problems. The knee may become more and more unstable. Over time, osteoarthritis may develop.

Trying rehab and other treatments

A child with an ACL injury can sometimes be treated without surgery to avoid damage to the child’s still-developing bones. Your child can try rehab exercises, wearing a brace, and avoiding activities that require jumping or twisting.

Studies suggest that the more active a child is, the less likely these treatments will work and the more likely surgery will be needed in the future.

An avulsion fracture is more common in young children. This happens when the ligament and a piece of bone separate from the rest of the bone. It can often be treated with a cast. But it sometimes needs surgery.

Having the ACL surgery

You may consider surgery if:

  • The knee is very unstable doing simple daily activities.
  • The knee can’t be made stable with other methods.
  • The child has both an ACL injury and a meniscus tear.
  • The child is a serious athlete in sports that require running, jumping, and stopping quickly.

Rest after surgery and a proper rehab program are very important.
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As children and teenagers are more flexible, in this age group back pain is not common as compare to adults. Only about 1 to 4 young competitive atheletes and 1 on 6 young recreational atheletes will have occasional back pain. Back pain in children that happens immediately after an injury or an atheletic event should be checked by a doctor.

Overuse injury can cause back pain in children. As overuse back injury happens gradually, children or parents may not be able to remember what injury that triggers the back pain or when the back problem started. Carrying heavy backpack may increase a child’s chances of a back injury or problem.

Back pain that is very severe and limits a child’s daily activities or back pain that lasts for 2 weeks or longer, needs to be checked by a doctor.

Back conditions that affect children and teenagers

  • Pain that is made worse by specific movements, such as swimming, gymnastics, or contact sports, may be caused by spondylolysis or spondylolisthesis. Young athletes with low back pain have a higher risk of spondylolysis. These back injuries are usually caused by activity and overuse.
  • Scheuermann’s disease can cause pain to the back. However, it is not severe enough to affect the daily activities of your child. It is the second most common cause of back pain in children and teenagers. Scheuermann’s disease may cause your child to have a rounded spine.
  • If your child who is awakened by back pain during the night may have an infection, arthritis, or tumour of the spine.
  • Back pain that happens with changes in balance or coordination may be a cause in the brain or spinal cord.

Back pain symptoms may be caused by other problems that the children is having. If you suspect that your child is having a spine problem, bring them to see a doctor to check their spine.

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What is scoliosis?


Scoliosis
Scoliosis

Scoliosis is a medical condition in which a person’s spine is curved from side to side, shaped like an “s” or “c”, and the spine may also be rotated.

How is scoliosis diagnosed?


A rib “hump” or a prominent shoulder blade caused by rotation of the ribcage in thoracic scoliosis can be detected on physical examination. It is more prominent when the patient is bent forward. A special X-ray film called a scoliosis film will confirm the diagnosis.

Causes of scoliosis


There is no definite cause but most are due to developmental problems.

Prevention of scoliosis


Regular exercise and a good diet. Scoliosis is more likely to occur to low body weight patients.

There is no way to prevent idiopathic scoliosis. Early detection and treatment, if necessary, helps to prevent it getting worse.

If you have a history of scoliosis in your family, children can be checked regularly for scoliosis from the age of nine throughout their teens.

Treatments for scoliosis


Treatments include monitoring with regular medical check up to look for worsening of the curvature, bracing to help moderate cases and surgery may be necessary for the severe cases.

Scoliosis Doctor

Dr Mathew Tung, Spinal Specialist

Dr Mathew Tung Neurosurgeon